Resident Education and Virtual Medicine: A Faculty Development Session to Enhance Trainee Skills in the Realm of Telemedicine.

Introduction: COVID-19 accelerated the use of telemedicine. Subsequently, clinical sites began conducting virtual visits. Academic institutions implemented telemedicine for patient care and simultaneously had to teach residents the logistics and best practices. To meet this need, we developed a training session for faculty focused on telemedicine best practices and teaching telemedicine in the pediatric realm. Methods: We designed this training session based on institutional and society guidelines and faculty experience with telemedicine. Objectives included telemedicine documentation, triage, counseling, and ethical issues in telemedicine. We conducted all sessions in a 60-minute or 90-minute format over a virtual platform for small and large groups using case scenarios with photos, videos, and interactive questions. A novel mnemonic ABLES (awake-background-lighting-exposure-sound) was created to guide providers during the virtual exam. Following the session, participants completed a survey evaluating content and presenter effectiveness. Results: We presented the training sessions between May 2020 and August 2021 to 120 participants. Participants included pediatric fellows and faculty, reaching 75 participants locally and 45 nationally (at Pediatric Academic Society and Association of Pediatric Program Directors meetings). Sixty evaluations (response rate: 50%) showed favorable results for general satisfaction and content. Discussion: This telemedicine training session was well received by pediatric providers and addressed the need for training faculty to teach telemedicine. Future directions include adapting the training session for medical students and developing a longitudinal curriculum that applies telehealth skills learned with patients in real time.

Screening for behavioural problems in children aged 3 to 5 years.

OBJECTIVE: We aim to investigate the association between undergoing behavioural screening and having a diagnosis of behavioural problems and to explore factors associated with receiving treatment with counselling versus medication in children 3 to 5 years old. METHODS: This cross-sectional data analysis consisted of children 3-5 years old from the US National Study of Children's Health, 2017-2018. Pearson's χ2 test was used to assess the association between formal and informal screening and having a behavioural problem. Prevalence of behavioural screening, behavioural problems, and covariates were calculated. Survey binomial logistic regression was used to evaluate the association between formal and informal screening and treatment with counselling versus medication in children with behavioural problems. RESULTS: A total of 7837 children 3-5 years old were included in the analysis. Combined formal and informal screening for behavioural problems was 18.1%, 12.3% of children had informal screening only, and 10.8% had formal screening, as reported by parents. Five percent of children had a diagnosis of behavioural problem, for which 6.8% had formal screening only, 16.5% had informal screening only, and 58% had both. Children who had both types of screening were about 10 times as likely to have behavioural problems, and about 4 times as likely if they only had informal screening. Children with behavioural problems who had both types of screening were about 5 times as likely to be treated with medication. CONCLUSION: Formal behavioural screening was low in children 3 to 5 years old but, when done in conjunction with informal screening such as addressing parental concerns, was associated with a diagnosis of behavioural problems and receipt of treatment with medication.

Calidad de las tromboplastinas utilizadas en el laboratorio clínico y en los equipos POCT y su impacto en la dosificación de acenocumarol en pacientes con terapia anticoagulante oral / Types of thromplastin used for INR determination in patients under chronic oral anticoagulant treatment: discrepancies that may affect the dose of coumarin derivatives needed for treatment safety

Antecedentes: El monitoreo del tratamiento con anticoagulantes cumarínicos se realiza a través del INR (International Normalized Ratio) que es el parámetro estandarizado del Tiempo de Protrombina. Las recomendaciones de la OMS indican que la precisión en el cálculo del INR puede ser mejorada usando reactivo de tromboplastina con Indice de Sensibilidad Internacional (ISI) bajo, considerándose como ISI de referencia internacional el valor 1,0. Debido a incongruencias observadas en los INR de pacientes controlados en el Servicio de Salud Metropolitano Occidente, comparando valores de muestra venosa con resultados de INR capilar obtenidos en el mismo paciente el mismo día y hora (con reactivos Tromboplastina de distinto ISI), se efectuó un ensayo clínico cruzado entre los distintos métodos. Materiales y métodos: En 100 pacientes se comparó INR venoso con dos tromboplastinas de diferente ISI (1,3 y 1,0) vs aquel efectuado con muestra capilar (ISI 1,0). Resultados: Los resultados del estudio muestran que a partir de valores de INR 3,0 las determinaciones obtenidas usando Tromboplastina de cerebro de conejo ISI=1,3 subestiman el valor de INR para un mismo paciente y una misma muestra. Conclusiones: El uso de Tromboplastina recombinante humana ISI 1,0 permite evitar la subestimación del INR en pacientes con mayor riesgo tromboembóli-co (indicación de INR objetivo más alto). Por ello, este método se adoptó en el control del TACO en pacientes controlados en el Servicio de Salud Occidente.

Background: INR (International Normalized Ratio) is the standard Prothrombin Time parameter for monitoring anticoagulant treatment with coumarin derivatives Recommendations of WHO indicate that precision in the calculation of the INR can be improved using thromboplastins with a low Index of International Sensibility (ISI=1,0). Discrepancies in INR obtained using either this technique or conventional rabbit brain derived reagents in the same sample in patients attending the Servicio de Salud Metropolitano Occidente (West Metropolitan Health Service) were observed. Our objective was to evaluate these discrepancies in a systematic way. Materials and methods: A comparative study was conducted using two thromboplastins of different ISI (1.0 and 1.3) for the calculation of venous INR in comparison with capillary INR in 100 patients. Results: The study showed that INR values may differ significantly according to the method used. In particular, rabbit brain thromboplastin ISI = 1.3 underestimates the value of INR in the range of INR ≥3.0. Conclusions: The use of human recombinant thromboplastin ISI= 1.0. for determination of INR may significantly decrease the risk of hemorrhagic complications in patients requiring higher levels of anticoagulation.

Psychometric validity of the parent's outcome expectations for children's television viewing (POETV) scale.

BACKGROUND: TV and other screen use are common among elementary school aged children with both potential benefits and harms. It is not clear why some parents restrict their children's screen use and others do not. Parent's outcome expectations for allowing their child to watch TV and other screen media, i.e. the perceived 'costs' and 'benefits,' may be influential. Our objective was to develop a measure of Parent's Outcome Expectations for Children's TV Viewing (POETV) and test the psychometrics of the resulting instrument among parents with children 6-12 years old. METHODS: An ethnically diverse sample (n = 311) of parents from Harris County, Texas completed measures for POETV, demographics, and parent and child TV viewing and other screen media use via an internet survey. The sample was randomly split and an exploratory factor analysis (EFA) was conducted among the first half of the sample separately for Positive and Negative POETV. A confirmatory factor analysis (CFA) assessed the fit of the resulting factors with the data in the second half of the sample. Internal reliabilities and Spearman partial correlations (controlling for confounders) of children's TV and other screen use with the resulting POETV factors were calculated for the full sample. RESULTS: EFA identified two factors for Positive POETV (Parent Centered; Child Centered) and two factors for Negative POETV (TV & Content Exposure; Prevent Other Activities). Follow up CFA confirmed moderate to good psychometric properties for both factor structures with the addition of four correlated errors in the Positive POETV model. Internal reliabilities were appropriate (Cronbach's alpha >0.7). Parent Centered Positive POETV and Child Centered Positive POETV were correlated with children's TV viewing on weekdays (0.14, p < 0.05) and weekends (0.17, p < 0.01) respectively. Both also correlated with other screen media use on weekends (0.20 and 0.21, p < 0.001). Prevent Other Activities Negative POETV was negatively correlated with children's TV viewing on weekdays (-0.16, p < 0.01), weekends (-0.14, p < 0.05) and other screen media on weekends (-0.14, p < 0.05). CONCLUSIONS: The Positive and Negative POETV scales offer a new tool to better define predictors of screen media parenting practices and child screen media use behaviors.

Hispanic parents of overweight and obese children and their outcome expectations for children's television viewing: a qualitative study.

OBJECTIVE: Explore parental outcome expectations (OE) regarding children's television (TV) viewing among parents of overweight or obese children. METHODS: Qualitative study using semi-structured interviews with 20 parents of 5- to 8-year-old overweight or obese children. RESULTS: Parent's positive OE for allowing TV viewing were the convenience of using TV for entertainment or as a babysitter. Hispanic parents would limit children's TV viewing to improve their children's health, restrict content, and promote other activities. Negative OE such as children misbehavior and the loss of positive OE for allowing TV emerged as reasons parents may not limit TV. CONCLUSIONS AND IMPLICATIONS: Although Hispanic parents expected to improve their child's health by limiting TV, the negative OE may prevent them from doing so. Interventions targeting children's TV viewing, as a strategy to fight childhood obesity, may be more effective if they promote parent's positive OE and address parent's negative OE for children's TV viewing.

Fotoprotección / Photoprotection

A nivel de la superficie terrestre las radiaciones emitidas por el sol están representadas por los rayos infrarrojos (56%); la luz visible (39%) y las radiaciones ultravioletas de onda larga (UVA), de onda corta (UVB) y UVC. La disminución de la capa de ozono, en el curso de los últimos años, incrementaría el riesgo de cáncer de la piel (basocelular, espinocelular y melanoma maligno) así como de envejecimiento cutáneo. Lo anterior explica la importancia de la fotoprotección y el auge de los filtros solares físicos y muy especialmente de los químicos, cuyas ventajas y limitaciones se exponen y discuten en este artículo.

Estudio materno-infantil de enfermedad de Chagas en zonas endemicas: IV. Santiago; Región Metropolitana Chile / Maternal-child study of Chagas'disease in endemic areas: IV. Metropolitan Region of Santiago, Chile

En un total de 1.476 muestras de sangre de cordón, procedentes de la Maternidad del Hospital San Juan de Dios de Santiago, se estudió la prevalencia de la infección por Trypanosoma cruzi mediante métodos serológicos y la incidencia de la transmisión transplacentaria del parásito en los casos positivos. El estudio demostró una prevalencia de 0,94% y el diagnóstico de infección chagásica congénita se descartó en los 13 niños que presentaron serología positiva. Estos resultados difieren de lo observado en un estudio preliminar, que se había practicado en 402 muestras recolectadas 4 años antes en el mismo establecimiento